Windsor Camille, Joseph Adrien, Pons Stephanie, Mokart Djamel, Pène Frederic, Kouatchet Achille, Demoule Alexandre, Bruneel Fabrice, Nyunga Martine, Borcoman Edith, Legrand Matthieu, Darmon Michael, Zafrani Lara, Azoulay Elie, Lemiale Virginie
Medical Intensive Care Unit, APHP Saint-Louis University Hospital, Paris, France.
Human Immunology and Immunopathology, Institut National de la Santé et de la Recherche Médicale (INSERM) U 976, University of Paris Cité, Paris, France.
J Intensive Med. 2024 Sep 24;5(1):64-69. doi: 10.1016/j.jointm.2024.07.005. eCollection 2025 Jan.
Cancer patients who are exposed to sepsis and had previous chemotherapy may have increased severity. Among chemotherapeutic agents, anthracyclines have been associated with cardiac toxicity. Like other chemotherapeutic agents, they may cause endothelial toxicity. The aim of this study was to evaluate the effect of anthracycline treatment on the outcome of cancer patients with sepsis.
Data from cancer patients admitted to intensive care units (ICUs) for sepsis or septic shock were extracted from the Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique database (1994-2015). Comparison between patients who received anthracycline and those who did not was performed using a propensity score, including confounding variables (age and underlying diseases). A competing risk adjusted for severity of illness (Sequential Organ Failure Assessment [SOFA] score) was used to analyze the duration of vasopressor requirement.
Among 2046 patients, 1070 (52.3%) patients who received anthracycline were compared with 976 (47.7%) who did not. The underlying disease was mostly acute hematological malignancy (49.2%). Sepsis, mostly pneumonia (47.7%), had developed 2 days (interquartile range [IQR]:1-4 days) prior to ICU admission. Most patients (=1156/1980,58.4%) required vasopressors for 3 days (IQR: 2-6 days). Factors associated with the need for vasopressors were aplasia (hazard ratio [HR]=1.72, 95% confidence interval [CI]: 1.21 to 2.47, =0.002) and day 1 respiratory SOFA score (HR=7.07, 95% CI: 2.75 to 22.1, <0.001). Previous anthracycline treatment was not associated with an increased risk of vasopressor use. The duration of vasopressors was not different between patients who received anthracycline and those who did not (=0.79). Anthracycline was not associated with ICU mortality.
Previous anthracycline treatment did not alter the course of sepsis in a cohort of cancer patients admitted to intensive care with sepsis.
曾接受化疗且发生脓毒症的癌症患者病情可能更严重。在化疗药物中，蒽环类药物与心脏毒性有关。与其他化疗药物一样，它们可能导致内皮毒性。本研究旨在评估蒽环类药物治疗对脓毒症癌症患者预后的影响。
从肿瘤血液学重症监护研究组数据库（1994 - 2015年）中提取因脓毒症或脓毒性休克入住重症监护病房（ICU）的癌症患者的数据。使用倾向评分法对接受蒽环类药物治疗的患者和未接受该治疗的患者进行比较，倾向评分纳入了混杂变量（年龄和基础疾病）。采用根据疾病严重程度调整的竞争风险模型（序贯器官衰竭评估[SOFA]评分）分析血管活性药物使用时长。
在2046例患者中，1070例（52.3%）接受了蒽环类药物治疗，976例（47.7%）未接受。基础疾病大多为急性血液系统恶性肿瘤（49.2%）。脓毒症多为肺炎（47.7%），在入住ICU前2天（四分位间距[IQR]：1 - 4天）发生。大多数患者（=1156/1980，58.4%）需要血管活性药物3天（IQR：2 - 6天）。与需要血管活性药物相关的因素有再生障碍性贫血（风险比[HR]=1.72，95%置信区间[CI]：1.21至2.47，=0.002）和第1天的呼吸SOFA评分（HR=7.07，95%CI：2.75至22.1，<0.001）。既往蒽环类药物治疗与使用血管活性药物的风险增加无关。接受蒽环类药物治疗的患者和未接受该治疗的患者血管活性药物使用时长无差异（=0.79）。蒽环类药物与ICU死亡率无关。
在因脓毒症入住重症监护病房的癌症患者队列中，既往蒽环类药物治疗未改变脓毒症病程。
